Cain Bros.: Gap Between Haves and Have-Nots in Skilled Nursing Could Widen

Pressured by already light coffers and razor-thin margins, skilled nursing facilities could see an even wider gulf grow between top and bottom performers under the new Medicare payment model. That’s at least according to Cain Brothers director Taaha Shaikh, who this week wrote a commentary calling the coming Patient-Driven Payment Model (PDPM) “the next great […]

Shorter Stays Bring Rewards Under PDPM — But Only to a Point

Skilled nursing providers might be able to reap financial gains under the new Medicare payment model taking effect in October of this year if they can cut their average patient length of stay (LOS). But the gains will only hold until a certain point, and providers that already have shorter LOS —- such as short-term […]

Crackdown on Improper Medicare SNF Payments May Cost More Than It Saves

The Department of Health and Human Services (HHS) made a splash last month when it claimed that skilled nursing facilities received $84 million in Medicare payments for treatments that didn’t qualify — but now a group of doctors claims that the proposed cures might be worse than the disease. Writing in a blog post for […]

Amid Changes, Downstream Partnerships Will Become Vital to Skilled Nursing Quality

Skilled nursing facilities are facing increasing pressure to be more aware of the full spectrum of a patient’s care, with the rise of value-based purchasing (VBP) programs and accountable care organizations. And when the new Patient-Driven Payment Model takes effect on October 1, that won’t be possible if individuals are making decisions on their own. […]

Scrutiny About Behavior Changes Under PDPM Will ‘Inevitably’ Come to Skilled Nursing

The changes in Medicare reimbursement taking effect in October will mean upheaval in more places than a skilled nursing facility’s billing department. It will mean changes in the nuts-and-bolts processes of patient care, and SNFs need to be preparing for this reality — with the knowledge that regulators will be watching closely. That’s according to […]

Deadline for SNFs to Dispute Value-Based Penalties Nears — But Some Claims May Be Too Old

Skilled nursing facilities officially have until the end of March to submit corrections related to their quality measure information under the SNF Value-Based Purchasing (VBP) program, which offers incentive payments for facilities that reach certain readmission benchmarks — as well as penalties for those that fail. But it might not be possible to complete the […]

Doctors, Software, Training: Preparing for ‘Non-Negotiable’ PDPM Coding Pressures

Starting October 1, skilled nursing facility operators will have no choice but to become proficient with a specific type of medical coding that previously had no bearing on reimbursements — and leading industry voices say there are multiple paths to getting there. ICD-10 codes, specific diagnosis identifications long used by hospitals, will play a key […]

PDPM’s Effects Could Stretch Far Beyond Medicare for Skilled Nursing Facilities

On paper, the Patient-Driven Payment Model (PDPM) will only affect one pillar of the payment equation for skilled nursing facilities. But as players start to unpack the coming rule changes, PDPM’s reach begins to extend far beyond Medicare. Medicare Advantage and Medicaid frequently base rate calculations on the existing Medicare structure, a pair of experts […]

MedPAC Again Calls for $2B in SNF Cuts, But Also Urges Caution Amid PDPM Shift

The Medicare Payment Advisory Commission (MedPAC) on Friday again called for up to $2 billion in cuts to skilled nursing reimbursements under Medicare — but with a caveat that the new payment model could cause significant changes for operators moving forward. The nation’s more than 15,000 skilled nursing facilities should not receive a scheduled 2.6% […]

Skilled Nursing Facilities Outperform Home Health on Readmission Rates: Study

Despite the increasing preference among payers and hospital partners to discharge residents to home health agencies, brick-and-mortar skilled nursing facilities are superior at reducing hospital readmissions — with one key caveat. After controlling for a variety of factors, residents sent from a hospital to the care of a home health agency had a 5.6-percentage-point higher […]

Hager: Shift from SNFs to Home Has Run Course, Therapy Costs to Drop 10% to 15% Under PDPM

Large-scale efforts to shift post-acute residents from skilled nursing facilities to the home health space have largely “run their course,” Genesis HealthCare (NYSE: GEN) CEO George Hager said Tuesday, while also predicting serious cost savings under the new Medicare payment model. Though industry leaders have long worried about payers’ growing preference for the lower-cost home […]

Trump Budget Plan Would Cut $845B from Medicare, $241B from Medicaid

The White House on Monday released a budget proposal that would substantially slash Medicare and Medicaid spending over the next decade. In part by adopting a site-neutral payment model for post-acute care under Medicare and converting the Medicaid system to block grants, the federal government would end up gutting more than $1 trillion from the […]

Nurses May Need to Shoulder Documentation Burdens Under PDPM

Once the new Medicare payment model takes effect, frontline nurses may prove vital to securing the proper reimbursements for skilled nursing services. The Patient-Driven Payment Model (PDPM) will place increasing pressure on nursing facilities to justify each resident’s need for Medicare-reimbursed skilled care, Zimmet Healthcare Services Group president Marc Zimmet said during a recent industry […]

Providers Can’t Fall for Therapy Myths When Preparing for PDPM

As skilled nursing facilities and rehabilitation providers across the U.S. prepare for the changes to Medicare payments coming in October, they have to make sure they don’t get sidetracked by a slew of misconceptions about what’s coming. That’s according to a Tuesday webinar by clinical management software provider Optima Healthcare Solutions, held in conjunction with […]

CMS to Crack Down on Staffing, Separate Short- and Long-Term Stays in SNF Star Rating Overhaul

The Centers for Medicare & Medicaid Services (CMS) on Tuesday announced stricter standards for its consumer-facing nursing home ratings, including a lower threshold for staffing penalties and new separate ratings for short-term and long-term stays. Starting April 24, CMS will automatically hand out one-star staffing ratings to buildings that have four or more days in […]

Diakonos, Leo Brown Mix Post-Acute with Private Pay at New $15M Skilled Nursing Facility

In an era of tight finances and legal caps on the number of beds, new skilled nursing developments are few and far between — with most of the action in recent years focused on higher-end, post-acute rehab facilities. The Diakonos Group’s latest development, a $15 million skilled nursing facility in Tulsa, Okla. with a total […]